T Nation

How to Reduce Estradiol? Scary High Labs (448)


#1

So recently I've had labs run. A while back I started taking androgel for t in the 200 range in March. I don't feel any better atm, likely due to high e2.

Recently I saw an endo at the polyclinic, who wants to put me on clomid, and drop the androgel, because he feels it'll be sufficient to restart my natural production, as the issue is pituitary, not testicular. He says a med I take, suboxone, is supressing lh and fsh. However I did not have new labs for the appointment.

However, upon running labs post appointment, of which I had to specifically request to run e2, some things came back abnormal.

My e2 serum levels, which weren't checked until now, are very high.

I'll post what I have of the labs below, they aren't being released all at once to me online.

Testosterone total serum 1070 (a big jump from gel)

Estradiol serum 448 (400 points over the normal high end)

My thyroid tests were all within the normal range.

My prolactin, which had been high at 16 (mri was clean) is now down to 8.

I do not believe he ran dhea, dht, and maybe not even fsh and lh.

Overall I came away feeling like I need to see a different doctor.

After seeing the e2 so high, I asked if an AI would be better suited. He said he felt like taking a half dose of androgel for two weeks, while taking clomid, would be fine. While aromatase is clearly an issue, is taking less t going to drastically improve my already sky high e2? The ratio of t to e is almost 2 to 1.

I also had been taking alpha from jym, which contains fenugreek, and tribulus. I also take 100mg dhea daily. I now understand these could raise e2 as well? I've also started using less androgel.

My igf was measured low a few months ago by another doctor as well, not sure of it's of consequence.

I have not started taking the clomid.

I'm going to try to start taking ic3, dim, and calcium d glutarate. But I think I really need an AI.

What should I do?


#2

[quote]Mk83z wrote:
So recently I’ve had labs run. A while back I started taking androgel for t in the 200 range in March. I don’t feel any better atm, likely due to high e2.

Recently I saw an endo at the polyclinic, who wants to put me on clomid, and drop the androgel, because he feels it’ll be sufficient to restart my natural production, as the issue is pituitary, not testicular. He says a med I take, suboxone, is supressing lh and fsh. However I did not have new labs for the appointment.

However, upon running labs post appointment, of which I had to specifically request to run e2, some things came back abnormal.

My e2 serum levels, which weren’t checked until now, are very high.

I’ll post what I have of the labs below, they aren’t being released all at once to me online.

Testosterone total serum 1070 (a big jump from gel)

Estradiol serum 448 (400 points over the normal high end)

My thyroid tests were all within the normal range.

My prolactin, which had been high at 16 (mri was clean) is now down to 8.

I do not believe he ran dhea, dht, and maybe not even fsh and lh.

Overall I came away feeling like I need to see a different doctor.

After seeing the e2 so high, I asked if an AI would be better suited. He said he felt like taking a half dose of androgel for two weeks, while taking clomid, would be fine. While aromatase is clearly an issue, is taking less t going to drastically improve my already sky high e2? The ratio of t to e is almost 2 to 1.

I also had been taking alpha from jym, which contains fenugreek, and tribulus. I also take 100mg dhea daily. I now understand these could raise e2 as well? I’ve also started using less androgel.

My igf was measured low a few months ago by another doctor as well, not sure of it’s of consequence.

I have not started taking the clomid.

I’m going to try to start taking ic3, dim, and calcium d glutarate. But I think I really need an AI.

What should I do?[/quote]
Hi.
Some conclusions and questions.

Very high E2 levels, it’s in pg/ml yes?
You should always include reference ranges not everyone live in the states.

When on trt your Lh would be pretty much 0 so no point testing it during the treatment. With clomid it’d be different thing. Prolactin isn’t affected by trt.

Suboxone aka buprenorphine affects your hormones radically.

The study above is far from complete and only gives us little glimpse and lots of guesses of what’s going on with long term usage.
It clearly suggests that buprenorphine raises t-levels quite a bit which always means more testosterone to estrogen conversion.

On top of buprenorphine you’re taking testo gel which again raises your testosterone and therefore estrogen.

With your medication in action, there’s absolutely no need for products like Alpha and you can do with far less amount of dhea aswell.

So your high testosterone levels ain’t from gel alone in this case, only part of it is. Clomid could cause estrogen rebound when tapering so does arimidex. You might want to consider aromasin but it’s a different thing again.

Were your T levels tested while on buprenorphin only, or did you start it after your trt?

Are you taking opioids? If, that will affect E2 also.
Why buprenorphine is prescribed to you?
What gel dose do you use and how strong the gel is?

You always could measure your T levels and e2 while being on buprenorphin alone, the studys levels of 18 nmol/liter are totally okay if you can achieve that with bupre alone. I’m taking sustanon 250mg/ml 1cc every 10th day and i always measure 19nmol/l after 8th days of injection.

Can’t comment atm the dual use of buprenorphin and clomid, need to study it more at some point.


#3

High E2 leads to increased SHBG, lowering FT and inflating non=bioavailable T+SHBG that increases TT.

Your high E2 will make you feel bad. With anastrozole, try to get near E2=22pg/ml.

Transdermal T has the highest T–>E2 potential of all delivery methods. Injections are 100% absorbed and least cost.

Please read these stickies:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections

That much DHEA is stupid and some freely convert to E2.
Your DHEA-S was low?
Do not test DHEA, test DHEA-S
How old are you?

This "My thyroid tests were all within the normal range. " is a problem as the ranges include those with pathologies. Please read the thyroid basics sticky and check oral waking and mid=afternoon body temperatures as suggested.

Please post thyroid labs and ranges. We always need ranges.


#4

Sorry I didn’t include labs very well, it was a bad post from my phone. I’m 30 years old. I’ve been on suboxone almost 10 years, no steroid use, no other medications. Currently I take ~2mg daily, it was maybe 3mg 6 months ago. No medical conditions.

For the last couple of years, I’ve been feeling fatigued, mentally less sharp. I cut back my suboxone (which always made me feel manic if anything), no change, I started exercising regularly, lost about 30 pounds, and didn’t really feel much better. Maybe a year ago my PCP ran labs, everything “normal” except testosterone, which was ~250.

I then saw a urologist, that ran more labs which I’ll include below. T was ~270 a He prescribed angrogel and ran an MRI due to high prolactin, which was clean.

Here are my labs from last week, this looks to be everything he tested for (no dhea-s. Format is range then my reading):

TESTOSTERONE,TOT SRM 241.00 - 827.00 ng/dL 1070.60
ESTRADIOL <47 pg/mL 448 (does something this high even make sense, is this even possible?)
PROLACTIN 2.6 - 13.1 ng/mL 8.8
FREE T3 2.2 - 4.3 pg/mL 3.3
TSH 0.340 - 5.600 uIU/mL 1.758
THYROXINE,FREE 0.57 - 1.25 ng/dL 0.85
ANTI THYROGLOBULIN <4
ANTI TPO 0 - 9 IU/mL 0
PSA,SERUM 0.0 - 4.0 ng/mL 0.8
FERRITIN 24 - 336 ng/mL 56
HGB A1C <5.7 % 4.8
A1c values of 5.7-6.4 indicate an increased risk for diabetes mellitus. A1c
values of greater than or equal to 6.5% are diagnostic of diabetes mellitus.
The ADA recommends A1c values of less than 7% as the goal for diabetic
therapy.
EST AVG GLUCOSE 91
Estimated Avg. Glucose is calculated from the HgbA1c
SODIUM 136 - 144 mEq/L 140
POTASSIUM 3.6 - 5.2 mEq/L 4.3
CHLORIDE 101 - 111 mEq/L 99
TOTAL CO2 22 - 32 mEq/L 33
ANION GAP 5 - 15 8
GLUCOSE 60 - 99 mg/dL 83
Normals are for fasting, no normals for random.
UREA NITROGEN 8 - 20 mg/dL 25
CREATININE 0.5 - 1.5 mg/dL 1.0
CALCIUM 8.9 - 10.3 mg/dL 9.6
PROTEIN, TOTAL 6.1 - 7.9 g/dL 7.2
ALBUMIN, S 3.5 - 4.8 g/dL 4.5
GLOBULIN 2.3 - 3.8 g/dL 2.7
A/G RATIO 1.0 - 2.0 1.7
BILIRUBIN, TOTAL 0.3 - 1.2 mg/dL 0.7
AST(GOT) 15 - 41 U/L 38
ALT (GPT) 17 - 63 U/L 38
ALK PTASE 38 - 126 U/L 52
EGFR >60 mL/min 88
EGFR (BLACK) >60 mL/min 106

Here are my labs pre androgel about 6 months ago at the end of February (format is my reading then range, note test reading are in pg/ml):
LH 4.2 m[iU]/mL 1.7-8.6
FSH 5.4 m[iU]/mL 1.5-12.4
PROLACTIN 16.8 ng/mL 4.0-15.2
AFPTUMORMRKR 1.4 ng/mL 0.0-8.3
QNTBETAHCG <2 mIU/mL [iU]/L 0-3
SHBG 20.5 NMOL/L 16.5-55.9
TESTOS TOTAL 2760.0 pg/mL Units converted. See lab report for original value.
TESTO, FREE 6.3 pg/mL 9.3-26.5

So my prolactin has dropped considerably, not sure if that is of any consequence.
My endocrinologist stated specifically that suboxone decreases testosterone, most research I’ve done seems to jive with this. Perhaps some see increased testosterone when on it, I certainly did not. I believe he said it was a result of how it acts on LH and FSH, though not sure.

Upon first starting TRT, I was given testim samples, which made me feel great, slept better, much better libido, felt more rested, clearer head, etc. These were dosed at 50mg daily IIRC. Insurance didn’t cover it though, so I was given androgel. This didn’t seem to have the same effect, so the urologist upped the dose, 60mg daily, or 3 pumps. It didn’t seem to have an effect.

I have put on muscle, but I’m not sure if it’s an abnormal amount for 6 months, maybe 10-15lbs, and I’m a newbie to lifting in the last 12 months. Again, not extremelyu concerned about the anabolic effects of TRT, just want to be feel better, and get normal results in the gym.

The endocrinologist wants to use clomiphene, even after seeing the new labs. I said I was extremely uncomfortable with a treatment plan that didn’t directly address my e2 levels. Originally, he didn’t even think running e2 was important, and only ran them at my request. I’ve asked him to use an AI instead of clomiphene, paired with reducing my androgel, to get e2 under control, then re-evaluate.

I have to give a big thanks to people here, through lurking, and checking out threads, I’ve been able to learn just enough to ask better questions (like can you run my e2 levels).

Already I’m trying to get in to see another endocrinologist through the UW clinics, but it took me 2 months just to get in to see this guy.

In the mean time, what if anything can I do to get e2 down? I think an AI is an obvious place to start, but I’d really rather have this prescribed, than take 2 weeks waiting for a questionable non-pharmacy AI.


#5

ESTRADIOL <47 pg/mL 448
Does not seem right. Range for males is <42
Get a second test or retest, perhaps from another lab.

FREE T3 2.2 - 4.3 pg/mL 3.3
TSH 0.340 - 5.600 uIU/mL 1.758
THYROXINE,FREE 0.57 - 1.25 ng/dL 0.85

fT3 looks good
TSH should be closer to 1.0
fT4=0.57 is too low, should be closer to mid-range = 1.05
Have you not been using iodized salt and are iodine deficient?
Please post oral body temperatures as per the thyroid basics sticky.
If body temps are low, rT3 may be elevated and blocking fT3.

Action items:
retest E2
Body temperatures, thyroid/iodine issues


#6

Can you explain the e2 cutoff? Are you saying that because the cutoff for men is wrong, they might not have applied an appropriate test/measurement?

I’ll post some body temperatures according to the sticky.

Hopefully it doesn’t take too long to see another doctor.

How much do e2 tests cost out of pocket? I’m not sure what insurance will cover if a doctor doesn’t order the labs.


#7

Also, I looked, and my only salts do not contain iodine. Is that something that can be tested for?


#8

Also, not really a big deal, but the study linked above doesn’t seem to suggest that buprenorphine increases testosterone, rather that it did not cause hypogondism similar to high dose methadone, showing similar labs to the control group. However, they don’t mention the dosage or duration of buprenorphine. Further, it wouldn’t surprise me if naltrexone, which is part of suboxone, also has an impact on hormones.

Finally, I think there’s pretty clear evidence of people on suboxone suffering from low t, though I can’t say the mechanics behind it, simply that in some, there’s a clear correlation.

I was never heavy opoid user, though I certainly have been on suboxone a very long time.

So on my list:
Body temps
Retest e2
I stopped potential problem supplements a few days ago.
I’ve also been using less androgel, about half.

Is there anything else I should do? I have the clomid, but haven’t taken it, as it doesn’t seem to offer a solution to the e2 problem.

Also am I correct in thinking my t is very high for just androgel, given I was in the 200s 6 months ago?

I understand this number might be artificially high due to e2 effecting t through sbgh as described above.

I also take zma, I’ve read zinc can have a favorable impact on e levels, should I continue this?

Is an Endo pretty much my best and only option? It seems like it takes a really long time to see them.


#9

In any case, if E2=448, you need to know if a transcription error or a lab error and get retested to avoid treatment based on a error. So you need to get that resolved.

I would not reduce T dose base on that E2 result at this point.

The amount of zinc in ZMA is fine, but more zinc in other supplements?

Endos are often the worst of the worst.

See these stickies:

  • finding a TRT doc
  • advice for new guys
  • thyroid basics

#10

are you sure your estrogen wasn’t taken in pmol/L unit?

my estradiol is slightly above yours, which still exceeds the “350 pmol/l” or less cut out for men, and even at 350, it would be much higher then the advised norm.


#11

[quote]Mk83z wrote:
Also, not really a big deal, but the study linked above doesn’t seem to suggest that buprenorphine increases testosterone, rather that it did not cause hypogondism similar to high dose methadone, showing similar labs to the control group. However, they don’t mention the dosage or duration of buprenorphine. Further, it wouldn’t surprise me if naltrexone, which is part of suboxone, also has an impact on hormones.

Finally, I think there’s pretty clear evidence of people on suboxone suffering from low t, though I can’t say the mechanics behind it, simply that in some, there’s a clear correlation.

I was never heavy opoid user, though I certainly have been on suboxone a very long time.

So on my list:
Body temps
Retest e2
I stopped potential problem supplements a few days ago.
I’ve also been using less androgel, about half.

Is there anything else I should do? I have the clomid, but haven’t taken it, as it doesn’t seem to offer a solution to the e2 problem.

Also am I correct in thinking my t is very high for just androgel, given I was in the 200s 6 months ago?

I understand this number might be artificially high due to e2 effecting t through sbgh as described above.

I also take zma, I’ve read zinc can have a favorable impact on e levels, should I continue this?

Is an Endo pretty much my best and only option? It seems like it takes a really long time to see them.[/quote]

I missed the methadone point in the study and you are right.
I take around 60-90mg zink daily.
Any sane doctor will do bro, endos are waste of time.


#12

It definitely says pg/ml on the e2 test.

On the topic of the Endo, yes not good, will have to find a good trt doc.

His philosophy was basically low t non testicular = clomid.

I’m pretty mad he didn’t even run free test and I missed it.

Will free test effectively measure how much my body has to absorb, that is unless the androgen receptors are flooded with e2?

Is there a certain thing I should request when getting an e2 test?

Are the numbers so high, they must be errant? Like I haven’t grown tits yet at least, though my symptoms at least match elevated e2 levels, though I’ll definitely retest.

I ordered some liquidex to have on hand if the test comes back elevates, until I can see a good trt doc.


#13

After reading how to finda trt doc, I’m curious, is it wrong to discuss doctors? I have more of a desire to find a doctor familiar with trt and interpreting labs, than one that’ll just write scripts and leave me flying solo. I’m not sure if pursuing a University of Washington endocrinologist is worthwhile, they are more research oriented, though they still take on patients.


#14

[quote]Mk83z wrote:
After reading how to finda trt doc, I’m curious, is it wrong to discuss doctors? I have more of a desire to find a doctor familiar with trt and interpreting labs, than one that’ll just write scripts and leave me flying solo. I’m not sure if pursuing a University of Washington endocrinologist is worthwhile, they are more research oriented, though they still take on patients.[/quote]

I found trt doc who was supposed to be good.
He prescribe me stuff and left me on a solo discovery trip.
He didn’t get my elevated E2 at all, was around 58 pg/ml and he told it’s perfectly okay. I got him to prescribe me anastrotzole but due to my work i haven’t experimented with it myself yet. Also i was planning to switch to very long acting Nebido instead of sustanon.


#15

So I’m going to go ahead and get labs.

Without worrying about insurance, it looks like LEF has decent value.

The basic men panel seems to have the best value
Dhea s, e2, free total test, and psa.

I’m not entirely sure the $75 for these tests is all that much more than they’d be with insurance.

I’ve viewed the stickies, what is testicular aching a sign of?


#16

Testicular ache can be from:

  • very low LH/FSH
  • infection/inflammation
  • vascular abnormalities

E2 labs in LEF male panels are good.
Until we have confidence in E2 results, hard to take action.

Don’t go nuts with zinc, you can create other problems.

If you change T dose and do labs soon after, the results may not be very useful. Need labs that reflect your steady state on a known dose.

So on my list:
Body temps !!!


#17

This may be an odd question, but do the LEF prices include the blood draw? Like I just buy the test from LEF, and show up to a listed lab for the draw? I don’t live in one of the states that say you have to mail it


#18

How long after working out do we need to wait to measure body temp? I trained about 2 hours ago, and at 9pm my body temp is 98.5

Are night sweats a function of body temp? I generally have problems sweating at night, especially lately. For a few years it’s felt like I get hot flashes.

Will measure again in am, and mid day.

I usually consume caffeine 100mg or so daily via coffee, do I need to worry about this increasing body temp and skewing results?

Also in an attempt to limit pituitary interference from meds, my doctor gave me subutex to replace suboxone, which is free from naloxone/naltrexone.


#19

AM temp was 97.0


#20

97 is low. Testing when you first wake up also removes opportunity for altering temperature of oral cavity.

— Are you iodine deficient? Using iodized salt and/or vitamins listing iodine+selenium?

Two hours after training, your body temps should be normalized. Keep sampling temperatures.

I don’t understand night sweats. I do sleep under a sheet and thin cotton blanket in a cool room as I get hot easily and have a low heat tolerance. Some guys report hot flashes from low T - mechanism not understood.

I would expect that you will have to pay for lab draw, but you will find out soon. For most, there is no added cost.

Caffeine may affect temperatures, but know knowledge of that. And most of use consume coffee…